What If U.S. Healthcare CAN’T Be Fixed?

What if Americans are too divided to reach any common ground? Or what if healthcare has become so rigged and so enmeshed that it can’t be untangled? Or what if vested interests have become so powerful that they can’t be overcome?

Beyond Intractability undertakes to look at the planet’s most bitter conflicts involving irreconcilable disputes between intransigent opponents. They cite Rwandan post-genocide peacemaking, South African apartheid reconciliation, the Afghanistan war, Middle East peace, European immigration, and globalization, among others.

U.S. healthcare reform is similarly intractable, though perhaps not as dire, and thus can benefit from Beyond Intractability’s approach.

Beyond Intractability proposes overcoming intransigence and intractability with a combination of two strategies:

Principled negotiation

Systems theory

Principled Negotiation

Principled negotiation was perhaps most lucidly described by Harvard Law professor Roger Fisher and anthropologist William Ury in their delightful 1981 manual, Getting to Yes. Their mantra is:

Separate people from the problem;

Focus on interests, not positions;

Establish precise goals for the negotiation;

Work together to create options that will satisfy all parties.

Systems Theory

Systems theory asserts that many of the most vexing problems are too complicated for a mechanical approach but not so vast and random for a detached statistical approach. Systems have a multitude of moving parts, all interconnected in sometimes hidden and unpredictable ways. Examples of systems are natural weather events and ecology, as well as human economy, politics and history. Systems theory challenges us to understand problems of intermediate size and randomness using non-linear thinking. Here are some of the precepts of systems theory (described in a Beyond Intractability essay):

The whole is sometimes greater than the sum of the parts

Inputs to systems have variable and unpredictable outputs

Small inputs to a system can have large effects; large inputs can have small effects

Complex systems can produce novel, creative, “emergent” outcomes.

There are no “neutral observers.” Everyone observing is affecting the system.

There is not a single “objective reality” that describes the system’s outputs.

The definition of “the system” is arbitrary, since its bounds can always be reconceptualized with more or fewer elements.

See also my previous post and post about applying systems engineering to healthcare reform.

The conclusion is that conflict resolution negotiators have the prerogative to expand definitions, analyses, and goals that are bounded only by imagination and creativity in service of reaching agreement.

Beyond Intractability asserts that all people – not just elite leaders – can use these tools to influence the resolution of seemingly intractable conflicts. They call this Massively Parallel Peacebuilding.

Conclusion

There are powerful negotiating and systems analysis tools, such as described by Beyond Intractability, that can help move healthcare reform beyond intractability. All citizens can use these tools individually and collectively to move our American political, social, and economic system toward creative and practical solutions.